Carbapenem-resistant Pseudomonas aeruginosa strains: a worrying health problem in intensive care units

Abstract

Pseudomonas aeruginosa is one of the most common bacterium with a broad spectrum of human-associated infections. It is intrinsically resistant to many antimicrobial drugs, making carbapenems crucial in clinical management. The emergence and dissemination of carbapenemases among P. aeruginosa clinical isolates is a serious public health concern as it limits the options for the treatment of bacterial infections. Here, we described the molecular and epidemiological characteristics of 28 carbapenem-resistant P. aeruginosa strains isolated from patients hospitalized in an intensive care unit (ICU). The antimicrobial susceptibility of carbapenem-resistant P. aeruginosa strains was determined by broth microdilution. The presence of resistance genes was evaluated by PCR and DNA sequencing. Additionally, alterations in genes encoding P. aeruginosa outer membrane proteins were analyzed by PCR as well as SDS-PAGE. Clinical characteristics of the patients and the economic impact of hospitalization on the public health system were evaluated. PCR amplification showed that the bla KPC-2 and bla TEM genes were identified in three isolates (11%) and bla SHV gene in two isolates (7%). Outer membrane profiles obtained by SDS–PAGE indicated that the OprD porin was either absent or was produced at very low levels. A PCR assay using opr D-specific primers failed to show the presence of mutations in this gene. P. aeruginosa strains were isolated from 28 patients, among whom 43% (12/28) had sepsis, 31% (9/28) had respiratory failure, and 31% (9/28) had systemic arterial hypertension. A high mortality rate (39%) was observed in these patients, with an average duration of hospitalization of 34.6 days and a median cost of 3.275 dollars per patient. The production of carbapenemase was not the main mechanism of resistance in these strains. All carbapenem-resistant P. aeruginosa were isolated from patients hospitalized in the ICU. Besides the high mortality rate, many patients remained hospitalized for several days, resulting in a high cost of hospitalization for the public health system. Therefore, the evolution of this resistance and its dissemination should be actively monitored among critically ill patients to improve their health conditions.

Worldwide Dissemination of blaKPC Gene by Novel Mobilization Platforms in Pseudomonas aeruginosa: A Systematic Review

“…The 53 studies included in this review were conducted in American, European, and Asian countries. China (14 studies) [ 14 , 15 , 17 , 19 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ], Brazil (10 studies) [ 21 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ], and Colombia (9 studies) [ 22 , 26 , 27 , 28 , 29 , 51 , 52 , 53 , 54 ] were the countries with the most reported studies, followed by Puerto Rico (4 studies) [ 55 , 56 , 57 , 58 ], Chile (2 studies) [ 59 , 60 ], Argentina (2 studies) [ 61 , 62 ], Vietnam (1 study) [ 63 ], Trinidad and Tobago (1 study) [ 64 ], Nepal (1 study) [ 65 ], India (1 study) [ 66 ], Germany (1 study) [ 18 ], Spain (1 study) [ 6 ], and the USA (1 study) […”

Deciphering the molecular mechanisms underlying anti-pathogenic potential of a polyherbal formulation Enteropan®against multi-drug resistantPseudomonas aeruginosa

“…This effect of Enteropan pre-treatment on imipenem susceptibility was also confirmed in liquid culture, wherein Enteropan-pre-treated cells were observed to exhibit upto 21.43% higher susceptibility to imipenem (Figure 3F). Imipenem belongs to the carbapenem class of beta-lactams (Mansour et al, 2021), and carbapenem resistance among P. aeruginosa isolates are being viewed as a serious problem (Souza et al, 2021). Since this class of antibiotics are looked as a last resort for treatment of MDR P. aeruginosa (Pragasam et al, 2016), resistance modifiers capable of making this bacterium more susceptible to them can be of help in extending the lifespan of these antibiotics by allowing their use at lower doses.…”

Carbapenem-resistant Gram-negative bacteria (CR-GNB) in ICUs: resistance genes, therapeutics, and prevention – a comprehensive review

“…Resistance to carbapenem antibiotics through carbapenemase production is a less common mechanism ( 39 ). Out of 28 CRPA strains isolated in the ICU, only three strains produced KPC ( 40 ). However, carbapenemase production as a resistance mechanism appears to be increasingly common, with bla VIM in MBLs being the most commonly detected gene, typically encoded on plasmids that are highly capable of dissemination ( 38 ).…”